Nicotine-Replacement Therapy Riskier for Smokers in ICU

A new study has found that nicotine-replacement therapy (NRP), used to help reduce adverse events associated with nicotine withdrawal, may actually increase the risk of death for smokers admitted to the intensive care unit (ICU).

Researchers from the Mayo Clinic College of Medicine (Minneapolis, MN, USA) examined the safety of NRT in the ICU by reviewing the medical records of 112 smoking patients admitted to the ICU who received NRT during their stay, and compared patient outcomes between the NRT group and a control group. Among the patients who received NRT, 18 deaths (16.1%) occurred, compared with three deaths (2.7%) in the control group. The hospital mortality rate was 21.4% for the NRT group, compared with 5.4% in the control group. Furthermore, when researchers controlled for severity of illness, NRT was found to be an independent risk factor for mortality.

There were no statistically significant differences in age, gender, ethnicity, and severity of illness between the NRT group and control groups. The median ICU length of stay for the NRT group was 24.4 hours, compared with 22.6 hours for the control group. The median hospital length of stay was 29.6 hours, compared with 46.2 hours for the control group. The findings were presented at the 72nd annual international scientific assembly of the American College of Chest Physicians, held in October 2006 in Salt Lake City (UT, USA).

"In some critically ill patients, the development of nicotine withdrawal symptoms can worsen their prognosis. As a result, NRT is given to active smokers in the ICU to prevent nicotine withdrawal symptoms,” said lead researcher Amy Lee, M.D. "The hemodynamic effects of nicotine may lead to increased heart rate, systemic arterial blood pressure, and constriction of the coronary arteries. Although these potential adverse effects of NRT have not been shown to worsen the prognosis of healthy volunteers and patients with stable coronary artery disease, they may be detrimental in critically ill patients.”



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